New Dealer Form

Date YYYY-MM-DD (required)

Your Name (required)

Business Name (required)

Telephone Number (required)

Your Email (required)

Fax

Business Street Address (required)

Type of Business

Business Classification

Sole ProprietorshipPartnershipCorporation

State of Corporation

Subsidiary of (Name and Address)

Business Type (Check all that Apply)

Brick and Mortar Store - Please upload picture of store front with signCatalogOnline (Website)EBay Store (Username)Amazon Store (Store Name)Drop ShipRentalLaw EnforcementDefense InstructorFirst ResponseWholesale DistributorOther

Ebay Store-username

Amazon Store-Store Name

What are the average sales per year in this category?(required)

How did you hear about UDAP's products?(required)

I hereby certify that I am authorized to enter into contracts for (subject) company.
THIS INFORMATION IS COMPLETE AND ACCURATE TO THE BEST OF MY KNOWLEDGE. Name and Title (required)


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